- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.37 / $692.37 / $4,828.00
| Facility | | $692.37 | $692.37 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,538.78 / $6,598.98 / $13,089.90
| Facility | | $3,538.78 | $6,598.98 | $13,089.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,669.35 / $2,368.56 / $5,697.90
| Facility | | $1,669.35 | $2,368.56 | $5,697.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.59 / $2,165.44 / $4,486.54
| Facility | | $1,517.59 | $2,165.44 | $4,486.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.37 / $1,170.10 / $3,307.00
| Facility | | $692.37 | $1,170.10 | $3,307.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,388.00 / $3,500.00 / $6,361.00
| Facility | | $1,388.00 | $3,500.00 | $6,361.00 |